Biomedical subjects
Publications and source records attributed to Y Darbois.
Laparoscopy is a valuable diagnostic tool in salpingitis, which enables to recognize the severity of their evolution and their bacteriological etiology. However, it should not be advocated in all circumstances and it is necessary to specifically select the time when it will be the most useful.
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A randomised double blind controlled trial of 'epidural blood-patch' as treatment for post-dural puncture headache is presented. The method was successful in 11 out of 12 cases on its first application, the twelfth patient being relieved by a second procedure. None of six patients reported benefit from a 'sham' procedure. The rationale for the use of the technique is discussed.
This work is a report on the follow-up of 50 pregnant epileptic women who were looked after in the Gynaecological and Obstetric Service of La Pitié-Salpêtrière in Paris. These patients had a generalised form of the disease. Well controlled patients usually had simple pregnancies. On the other hand half of those who had frequent attacks were worse during the pregnancy. It is rare for complications to occur either in the mothers or the neonates. The element that is most serious is the risk of malformation, which is three times as great whatever treatment is used and it does seem to increase according to the number of attacks occurring during the pregnancy. It therefore seems important that all epileptics should be stabilised before each pregnancy and medication should be given and controlled. It is important all the same that these are at-risk pregnancies that require clinical and ultrasound supervision.
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141 patients who had lesions caused by human papilloma virus (HPV) in the vulva and vagina (63 cases) or in the cervix (78 cases) were routinely treated solely by using CO2 laser. The lesions were vaporized when they were localised to the perineum and in certain selected cases in the cervix after they had been examined colposcopically and had biopsies taken. We resorted to conisation when lesions were not completely visible or when they were associated with CIN III (severe dysplasia and carcinoma in situ). Vulvo-vaginal condylomata present with certain characteristics: the infected population is young (a mean age of 27), most (81%) have diffuse forms of the condition, of the partners examined 68% were contaminated. Association with flat cervical lesions with or without dysplasia is not rare (18% of cases). Finally, treatment using only CO2 laser seems to us to be disappointing: only 55% were cured after one treatment and 84% after repeated treatments. When the condylomatous lesions on the cervix were flat we found an associated intra-epithelial neoplasia (CIN) in 66% of cases. In these cases the mean age of the patients was 28 years when these were pure viral lesions and 33 years of age when there was an associated dysplasia. Here the results after laser treatment can be considered as satisfactory because they were respectively 97 and 94% of cures whether the lesions had or did not have dysplasia. On the other hand, in our series the junction between pavement and cylindrical cells was always visible after treatment with the laser, and that made it easy to follow up these patients.
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413 menstrual cycles were monitored in the first two years of the work of the In-Vitro Fertilization Unit in La Pitié-Salpêtrière. On-going pregnancies were achieved from the very first months of activity, with a level which stayed relatively constant in the first year. Technical changes were introduced and in particular a higher recovery rate of oocytes when ultrasound was used and above all when LH-RH analogues were used in the process of stimulation. It is this last point that seems to be the most interesting. In fact, when the results are examined there is a definite rise in the number of on-going pregnancies of which the level went up by 2.3 times as compared with using a classical protocol of Clomithene citrate and HMG. In the 153 cycles when D-Trp6 LH-RH was used, the percentage of on-going pregnancies was 13.7% for each cycle and 20% for embryo implants. Furthermore, it became possible to work out the dates for the patients and this appears to us essential as the numbers of couples attending increase.
Thirty-three cases of obstetrical paralysis of the brachial plexus have been seen in 15 years in the gynaecological and obstetrical department of the University Hospital Pitié Salpêtrière. The authors, from studying these cases, work out the factors that tend to bring about this pathological condition. They are: multiparity, excessive weight gain in pregnancy, fetal excessive growth, prolonged second stage of labour, instrumental delivery and shoulder dystocia in cephalic presentations. In breech presentations it is mainly faulty performance of the manoeuvres that are needed to deliver the shoulders. These lesions involve, in most cases, the roots of C5 and C6. Spontaneous regression occurs very often. The authors have found 25% of sequellae. It is difficult to prevent shoulder dystocia. It consists in realising well the size of the fetus and using instruments really sensibly when the presenting part is high in a primiparous woman. In a multiparous woman one has to be on the look-out for increasing macrosomia of the fetus and it is important to teach the manoeuvres that are necessary to deal with shoulder dystocia. As far as breech delivery is concerned the major risk is the delivery itself without there being any need for fetal or maternal criteria to alter matters. Therefore prevention in this presentation has to be the presence of a competent obstetrician at each delivery always.
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This experiment investigates CO2-laser-induced histological effects on fallopian tubes obtained during hysterectomies in women. Tubal transversal sections were performed at isthmic and ampullar sites. Forty strips were available for histological study of the cut section area. The role of different parameters such as radiation power and beam fractionation (continuous versus pulsed) on tissue lesions was assessed. In tubal microsurgery, the CO2 laser can be used as a scalpel with the predominant advantage of minimal tissular alterations. As a result of this study, our recommended parameters are the following: radiation power, 7-10 W; beam focalization zone, 0.2 mm; energy density, 20,000-35,000 W/cm2; continuous operation; moving speed, 1 cm/s.
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The accuracy and the low radiation dosage administered when tomodensitometry is carried out for pelvimetry has led us to specify the use of this technique in every day practice. We propose to make is still more reliable and to simplify it. We have correlated the measurements obtained on the ultrasound screen with those that have been obtained by measuring the dried pelvis and have sought ways of measuring directly the three fundamental diameters of the pelvis. We have achieved exact measurements within one millimeter. This very precise correlation has been reproduced when we examined skeletons using the tomodensitometer. Then, when we checked again the accuracy of these measurements, we used the method on pregnant women. We have taken two views and two slices: an AP view to study the contents of the uterus and the morphology of the upper strait; a profile view to measure the diameter between the promontory of the sacrum and posterior surface of the symphysis, and we have programmed the two following slices: a perpendicular slice at the level of the upper strait measuring directly the transverse median diameter; another slice at the level of the sciatic spines to measure directly the diameter between these spines. We present this method because it is very simple and absolutely precise and gives all the information that is necessary. The patient does not have to stay still for long and only has a small dose of irradiation. This procedure does not need the use of conversion tables, nor parallel rulers nor standardisation.
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Triploidy in a common chromosomal abnormality that gives rise to early abortion in most cases. Rarely triploidies carry on past the end of the first trimester. When they do they are always accompanied by severe intra-uterine growth retardation with occasionally molar changes in the placenta. These changes are different from hydatidiform moles but they can become malignant. The formal diagnosis of triploidy depends on the fetal caryotype.
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Forty-eight pregnancies were observed in 35 patients with hyperprolactinaemia divided into 3 groups according to their initial radiological appearances: normal sella turcica (Group I, n = 11), microadenoma (Group II, n = 12) or macroadenoma without suprasellar expansion, visual defect or pituitary deficiency (Group III, n = 12). Twenty-seven patients were treated with Bromocriptine (Br) from the outs six by adenomectomy + Br, one by adenomectomy alone complicated by meningitis and by corticotropic and thyrotropic hormone deficiencies, followed by amenorrhea despite normalisation of the hyperprolactinaemia requiring induction of a first pregnancy with Clomid. As regards the pregnancies induced by Br (43/48), Br was withdrawn at an early stage in Group I and in the majority of cases in Groups II and III. In all, 37 pregnancies came to term; after Br therapy we observed 5 spontaneous abortions and 3 premature deliveries; 2 caesarian sections were performed before term (one case of hypertension and one adenomatous expansion); one early termination was performed for a tumoral complication. One congenital abnormality (oesophageal atresis) was detected. These observations support the results of extensive studies showing no effects of Br on the outcome of pregnancy and no detectable teratogenic effects with this drug. Five pituitary complications occurred during pregnancy after withdrawal of Br; 1 case of headaches with expansion of a macroadenoma cured by adenometry after prophylactic caesarian section before term; 1 case of optic chiasma compression (Group III) which responded to emergency surgery and 2 cases of pituitary apoplexy (Groups II and III) which responded favourably to Br and in which pregnancy continued normally.(ABSTRACT TRUNCATED AT 250 WORDS)